Friday, June 12, 2020
She’s Not Handling This Well
The patient is a 65 year-old woman with a two-month history of hand dermatitis. She has had no new medications in a year and has been laid off from a job in sales due to Covid 19. After 25 years, she’s had to sell her house and is moving into an apartment in three days time. Holding up her hands up in front of her, without irony, she said, “I’m not handling this situation well.”
Clinical Exam: The palms of both hands are dry with marked scale plates. The dorsae of the hands are normal. There are no other cutaneous findings. In the photo above, there is a suggestion of Dennie-Morgan Lines. Her feet are normal.
Discussion: In the differential diagnosis I considered traumiterative hand dermatitis, psoriasis, contact dermatitis, tinea (KOH was negative).
But I keep wondering about that phrase in English, “She can’t handle it.” Why is that aphorism there? Did the Ancients know something we’ve forgotten?
She will be treated with clobetasol ointment employed with a “Soak and Smear” protocol. If she does not clear by a few weeks after her move, biopsy, patch testing, and a medical workup will be pursued, but she has other things on her plate just now.